Rouzer to vote in favor of AHCA
By Melinda Harrell
Published in News on March 23, 2017 9:57 AM
Rep. David Rouzer
Rep. David Rouzer, R-Dist. 7, who represents Wayne County, is set to vote in favor of the highly criticized Republican health care overhaul bill today.
The American Health Care Act, should it pass, would repeal and replace the Affordable Care Act, also known as Obamacare.
"I am going to vote for it," Rouzer said.
"It is the biggest entitlement reform in my lifetime. We are putting Medicaid on a budget, and that is one of the major drivers of the national debt. Medicaid reform is substantial. Putting an entitlement program on a budget will save the country billions -- trillions in the long-term really."
The bill changes Medicaid funding to states by offering the money through a block grant option, which is one lump sum, or through a per capita allotment, which would vary each year based on the number of eligible applicants.
It also freezes the Medicaid expansion funding, which North Carolina did not do, to the 2016 levels.
As it currently sits, the federal government gives 67 cents for every dollar North Carolina pays for Medicaid services.
Changing the way Medicaid is funded to one lump sum and locking in costs could penalize the states that have lean Medicaid programs. North Carolina comparatively has been a low-cost state with its denial of Medicaid expansion.
The state's Medicaid program is already lean, only providing coverage for qualifying children, disabled, elderly and pregnant women.
North Carolina Sen. Louis Pate, R-Dist. 7, Mount Olive, co-chair of the Appropriations on Health and Human Services Committee and member of the Appropriations/Base Budget Committee, said should the AHCA pass and federal funding be cut from the Medicaid program, the state would have to look at inefficiencies in the system on a state level.
"First of all, regardless of whether there is a reduction in money, we have to continue our efforts to wipe out fraud, waste and excess in the Medicaid system," Pate said.
"There is a huge amount being spent recklessly. That would go a long ways in cutting back Medicaid expenditures. We have to deliver medical care more efficiently, and if we are still behind the power curve we would have to look at other appropriations."
When asked if what would happen to Medicaid if the state's reform did not cover the costs of the potential federal cuts, Pate said a decision would have to be made at the state-level when the time comes.
"That will be a decision (that) would have to be made at that time, and we would have to make up the difference in some fashion," Pate said.
"I don't mean by cutting services, but if there are some services that are not needed we could do that, but we want to provide the same level of care."
N.C. Child, an advocacy group for children, is opposed to the measure, citing the bill would be detrimental to access to health care for children in the state.
"One of our primary concern is the structural changes in Medicaid program," said Sarah Vidrine, senior analyst with N.C. Child.
"This would cap the federal share that the federal government pays for the Medicaid program and by far the beneficiary of those services are kids. It also affects elderly, disabled and pregnant women. Our concern is the cap will not adequately cover children care and shift the burden to the state. And if the state is pulled too tight it could reduce the services to those desperately in need."
Vidrine also said N.C. Child is concerned about the tax credits offered in the AHCA. She said those credits are less than what is offered under the ACA, which would be detrimental to families trying to buy health insurance.
The Congressional Budget Office released the report earlier this month saying that millions would lose coverage due to the changes in Medicaid as well as the removal of the ACA subsidies and mandates.
According to the Kaiser Family Foundation, the AHCA tax credit would be $10,000 for a family of four making $40,000 a year. Under the ACA, the subsidy is $24,780, which means the same family faring well under the ACA would lose $14,780 for insurance coverage.
In contrast, in Wayne County a family of four with a household income of $150,000, who, under the ACA does not receive any insurance subsidy, would earn $10,000 for insurance under the AHCA tax credit plan.
As of 2014, 22.5 percent of residents in Wayne County live in poverty and the median household income is $41,174.
The average per capita income in Wayne County is $21,818.
"With the ACA repeal and some of the marketplace insurance and tax credits available, families and -- particularly those in Wayne for a family of four making under $75,000 year would have to pay a significant cost," Vidrine said.
To further exacerbate the problems of lower-to-middle-class families in Wayne County, the CBO also reports that premiums for single policyholders in the nongroup market would be 15 to 20 percent greater than under current law.
The CBO report put the reason for the increase on the dissolution of the individual mandate, which would remove the individual tax burden but would also eliminate the incentive for the healthier population to enroll for insurance coverage.
Rouzer called those mandates the "most onerous parts of Obamacare."
The AHCA plan did keep the requirement that insurance companies provide coverage to any applicant, including people with preexisting conditions, which could affect the overall premium amounts, according to the CBO report.
In the CBO report, by 2020 the premiums should become stable and be around 10 percent lower than under current law.
Rouzer said the tax credits have been modified since the initial release of the bill and criticized the CBO report for basing its numbers on the current insurance climate.
"(The CBO) assumes that Obamacare doesn't completely implode," Rouzer said.
"The trajectory is not sound. The cost of Obamacare is going to be so high. There are a lot of us that takes issue with CBO. All you have to do is look at the exchanges to know one-third of the counties have only one insurer on the exchange and many are saying they won't have any insurance product available. It is going to be a disaster for everyone."
Rouzer said to compare receiving a subsidy under the ACA today to what it would be in three or four years isn't valid because there will not be any insurance products to buy in the exchange once all insurance providers pulled out of the marketplace.
He also lauded the caveat that was an add-on to the AHCA that would require people to be employed to receive the tax credits at all.
"The other component is states now have the ability to require work in exchange to getting the refundable tax credit," he said.
"Those receiving refundable tax credits have to have employment or be doing something somewhere because we don't want it to be a welfare payment is the bottom line. If you work you ought to be better off if you don't work."
Vidrine said pushing through legislation that would repeal and replace the ACA without careful thought as to how it would affect families in Wayne County would be misguided.
"As a whole, it really will cause an enormous number of people to lose insurance and coverage and that includes kids, and it doesn't seem to me that rushing through the legislation without including how it would affect children and families is something we think the country should be going towards," Vidrine said.